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OBJECTIVE: The aim of this study was to provide geographic comparisons of deep brain stimulation (DBS) procedures in Latin America with the US and Europe regarding primary indications, demographic information, clinical and device-related adverse events, technology used, and patient outcomes using the Medtronic Product Surveillance Registry data as of July 31, 2021. METHODS: Two thousand nine hundred twelve patients were enrolled in the registry (2782 received DBS and 1580 are currently active). Fourteen countries contributed 44,100 years of device experience to the registry. DBS centers in Latin America are located in Colombia (n = 3), Argentina (n = 1), Brazil (n = 1), and Mexico (n = 1). Fisher's exact test was used to compare the difference in proportions of categorical variables between regions. The Wilcoxon signed-rank test was used for the EQ-5D index score change from baseline to follow-up. RESULTS: The most common indication for DBS was Parkinson's disease across all regions. In Latin America, dystonia was the second most common indication, compared to essential tremor in other regions. There was a striking finding with respect to age-patients were an average of 10 years younger at DBS implantation in Latin America. This difference was most likely due to the greater number of patients with dystonia receiving the device implants. The intraoperative techniques were quite similar, showing the same level of quality and covering the main principles of the surgeries with some variations in the brand of frames, planning software, and microrecording systems. Rechargeable batteries were significantly more common in Latin America (72.37%) than in the US (6.44%) and Europe (9.9%). Staging of the DBS procedure differed, with only 11.84% in Latin America staging the procedure compared with 97.58% and 34.86% in the US and Europe, respectively. The EQ-5D score showed significant improvements in all regions during the first 6-12 months (p < 0.0001). However, the 24-month follow-up only showed an improvement in the scale for Latin America (p < 0.0001). CONCLUSIONS: DBS was performed in Latin America with similar indications, techniques, and technology as in the US and Europe. Important differences were found, with Latin America implementing more regular use of rechargeable devices, including younger patients at the time of surgery, and showing more sustained quality of life improvements at 24 months of follow-up. The authors hypothesize that these disparities stem from differences in resources among regions. However, more studies are needed to standardize DBS practice across the world to improve patients' quality of life and provide high-quality care.
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The success of stereotactic surgery for Deep Brain Stimulation depends critically on the exact positioning of a microelectrode recording in a target area of the brain. This paper presents the software system NEUROZONE composed of two main applications: first, it allows online recognition of brain structures by the analysis of signals from microelectrode recordings (MER), and second, it processes and analyses off-line databases allowing the inclusion of new trained classifiers for automatic identification. The software serves as a support to the analysis done by a medical specialist during surgery, and seeks to reduce the adverse side effects that may occur because of inadequate identification of the target areas. The software also allows the specialists to label recordings obtained during surgery, in order to generate a new off-line database or increase the amount of records in an already existing off-line database. NEUROZONE has been tested for Deep Brain Stimulation performed at the Institute for Epilepsy and Parkinson of the Eje Cafetero (Colombia), achieving positive identifications of the Subthalamic Nucleus (STN) over to 85% using a naive Bayes classifier.
Assuntos
Mapeamento Encefálico/métodos , Estimulação Encefálica Profunda/métodos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Técnicas Estereotáxicas , Núcleo Subtalâmico/fisiopatologia , Cirurgia Assistida por Computador/métodos , Estimulação Encefálica Profunda/instrumentação , Eletrodos Implantados , Eletroencefalografia/métodos , Humanos , Sistemas On-Line , Reconhecimento Automatizado de Padrão/métodos , Núcleo Subtalâmico/cirurgiaRESUMO
BACKGROUND: The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. AIM: To report the experience of a Neurosurgical Service in chronic subdural hematoma. PATIENTS AND METHODS: One hundred patients (77 male, mean age 77 +/- 13 years) with chronic subdural hematoma were analyzed. RESULTS: The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation. CONCLUSIONS: Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome.
Assuntos
Drenagem , Hematoma Subdural Crônico/cirurgia , Fatores Etários , Idoso , Análise de Variância , Chile/epidemiologia , Feminino , Seguimentos , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Los quistes sinoviales (QS) de columna lumbar son lesiones infrecuentes pero deben considerarse frente a casos de compresión radicular. Existe controversia acerca de su patogenia y se describen múltiples opciones terapéuticas. Se presenta una serie clínica retrospectiva de siete pacientes tratados en un período de ocho años. En general fueron pacientes mayores de 60 años, con un cuadro de dolor radicular unilateral, que se presentó 3 meses antes del diagnótico. Sólo dos pacientes tuvieron déficit de la raíz correspodiente. Todos los QS se localizaron en el nivel L4-L5, realizándose hemilaminectomía y resección total del quiste. Seis casos tuvieron desaparición completa del dolor. Un paciente presentó sólo alivio moderado, constatándose espondilolistesis, por lo que fue sometido posteriormente a una fusión vertebral, mejorando su sintomatología. La cirugía es un tratamiento seguro y eficaz para la resolución de esta patología. La literatura acerca de esta importante patología fue revisada
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Vértebras Lombares , Radiculopatia/etiologia , Cisto Sinovial/complicações , Imageamento por Ressonância Magnética , Cisto Sinovial/cirurgiaRESUMO
La cirugía en hematomas intracerebrales espontáneos es aún un tema de gran controversia pese a los numerosos estudios publicados en la literatura. Se realizó una encuesta en el XXVII Congreso Latinoamericano de Neurocirugía, realizado en Honduras en el mes de octubre de 1996, en donde se preguntó sobre criterios empleados en la indicación de cirugía por los encuestados. Fueron analizadas las siguientes variables: localización, lateralidad, tamaño, nivel de conciencia y desviación de línea media en la tomografía computada (TC). La encuesta fue respondida por 118 neurocirujanos pertenecientes a 18 países latinoamericanos, 82 por ciento titulados y 18 por ciento residentes. Se encontraron algunas tendencias como operar los hematomas talámicos, controvertida la cirugía en hematomas putaminales, operar a los pacientes en sopor con volumen del hematoma con volumen del hematoma entre 20 y 80 cc y con desviación de la línea media en la TC mayor de 5 mm. Pese a tales tendencias generales no se encontró uniformidad de criterios entre los encuestados